射频消融前经食管心房调搏检查对阵发性室上速的诊断价值

目的 :探讨经食管心房调搏 （TEAP）电生理检查对阵发性室上性心动过速 （PSVT）的诊断价值 ,为射频消融（RFCA ）手术提供参考。方法 :选取初步诊断为阵发性室上性心动过速 ,欲行 RFCA患者 32 8例 ,在做 RFCA之前均先行 TEAP检查 ,应用多导心电图 （ECG）记录的诱发心动过速 ,将 TEAP时多导 ECG标测资料与心内电生理资料进行对比观察 ,评价 TEAP检查对 PSVT诊断价值。结果 :初诊为 PSVT且 TEAP检查成功者 32 8例中 316例TEAP诊断与心内电生理及射频消融结果符合 ,TEAP与心内电生理符合率为 96 .4 %。结论 :TEAP电生理检查是PSVT患者 RFCA术前分类诊断的准确方法 ,具有重要的临床应用价值     

经食管心房调搏终止室上性心动过速的影响因素

目的 探讨经食管心房调搏(transesophageal atrial pacing,TEAP)终止室上性心动过速(supraventricular tachycardia,SVT)的影响因素.方法 选择行TEAP时发生SVT并通过超速抑制终止的患者78例,按终止脉冲数分为脉冲数≤5个组(41例)和脉冲数>5个组(37例).比较两组患者的年龄、性别、输出电压、插管深度、心动过速类型及频率、终止频率、频率差值、SR延长间期、文氏阻滞点、2:1阻滞点对终止SVT的影响.结果 脉冲数>5个组的心动过速频率、终止频率明显高于脉冲数≤5个组(P<0.05).二元Logistic回归分析证实,心动过速频率是TEAP终止SVT的影响因素(OR=1.03,P=0.02).心动过速频率越快,超速刺激需要的脉冲数越多.结论 心动过速频率对TEAP终止SVT的脉冲发放次数有重要影响,临床操作时应予以密切关注.     

经食管心房调搏治疗室上性心动过速69例

阵发性室上性心动过速（PSVT）是临床常见的心律失常，严重的PSVT可导致心力衰竭、休克，立即中止其发作是治疗的主要目的之一。治疗方法：使用颈动脉窦按摩、按压眼球、咽喉刺激等方法多数患者不能有效中止发作。静脉使用抗心律失常药物如异搏定、心律平等药物可能出现抑制心肌收缩力及传导系统。而经食管心房调搏术能安全、有效、迅速中止其发作。2000年4月至2007年4月我们应用食管心房调搏治疗PSVT　69例，效果良好，报道如下。     

经食管心房调搏对阵发性室上性心动过速的诊断价值

目的 探讨经食管心房调搏对阵发性室上性心动过速的分型及定位诊断价值。方法 回顾性分析食管心房调搏对193例阵发性室上性心动过速分型及定位诊断结果，并与心内电生理检查诊断结果比较。结果 经食管心房调搏对慢-快型AVNRT及顺向性AVRT的诊断敏感性、特异性、准确性均较高，对少见型AVNRT的诊断敏感性低(25％)。结论 阵发性室上性心动过速发作时食管与体表心电图P^-波起始与极性是诊断阵发性室上性心动过速的关键。经食管心房调搏对心动过速旁道定位误诊原因主要是心动过速时体表心电图P^-波往往与T波融合，导致V1、I导联P^-波极性及V1导联P^-波起始部形态改变。     

食管心房调搏诊断室上性心动过速的局限性探讨

对１２０例室上性心动过速（ＳＶＴ）患者的食管心房调搏（ＴＥＡＰ）与心内电生理检查的结果进行比较，发现两者不符有２０例，进一步分析表明属ＴＥＡＰ漏诊或误诊，其原因除与ＳＶＴ自身的电生理特性有关外，更主要的是与ＴＥＡＰ方法学上存在一定缺陷有关。     

食管心房调搏治疗快速室上性心动过速

本文对38例阵发性室上性心动过速(PSVT)作食管心房调搏超速抑制治疗。结果 该法可作为PSVT的首选手段,方法简单、操作方便、无并发症、极为有效,值得推广,基层尤其适用。现对38例PSVT者经食管心房调搏超速抑制治疗,报道如下。 1 资料与方法 1.1 一般情况:男18例,女20例。年龄15～56(平均42.6)岁,均经兴奋和刺激迷走神经无效后,即用食管心房     

经食管心脏电生理检查对PSVT的诊断价值

目的 探讨经食管心脏电生理检查诊断阵发性室上性心动过速(PSVT)类型的价值.方法 2019年3月至2021年3月在本院收治的86例诊断疑似为PSVT患者进行食管心脏电生理检查,采用Kappa 一致性检验PSVT诊断准确率、灵敏度、特异性、阴性预测值、阳性预测值和Kappa值.结果 经食管心脏电生理检查诊断PSVT的K...     

经食管心房调搏终止特发性室速的临床体会

经食管心脏调搏不但是一种无创性心脏电生理检测技术,也是一种实用型很强的无创性临床心脏起搏技术。在治疗心律失常上也有重要实用价值。本文报告应用此技术成功终止几例特发性室速（VT）的临床体会。     

经食道心房调搏诊断阵发性室上性心动过速的临床价值

目的探讨经食管心房调搏（TEAP）检查诊断阵发性室上性心动过速（PSVT）的临床价值。方法纳入临床诊断为PSVT患者74例,通过TEAP检查予以诱发以及终止PSVT,记录并分析PSVT心电图参数,包括诱发窗口、诱发频率、房室结不应期等,并与心腔内电生理（IEPS）检查结果进行比较。结果 TEAP检查的诱发窗口、诱发频率、房室结不应期与IEPS检查结果相关性良好（P＜0.05）, TEAP检查诊断PSVT的符合率达83.8%（62/74）,诱发的PSVT均能通过TEAP予以终止。结论 TEAP检查可有效评估PSVT的电生理特性,准确率高,值得临床广泛应用。     

经食管心房调搏对阵发性室上速诱发与终止的临床价值

目的：研究经食管心房调搏对阵发性室上性心动过速（PSVT）诱发与终止的价值。方法：选择237例有心动过速发作史的患者进行食管心房调搏检查,如果诱发出阵发性室上速,进行12导联心电图记录后,予以短阵快速刺激或程序期前刺激终止之。另外对54例急诊PSVT患者直接予以短阵快速刺激或程序期前刺激终止之。结果：在被检的237例患者中诱发出PSVT148例,占62．4％（其中房室结双径87例,房室折返为61例）。对其202例PSVT患者均采用短阵快速刺激或程序期前刺激。PSVT即刻终止的有196例,转复成功率97％。结论：经食管心房调搏可作为PSVT筛选检查及终止的首选方法。     

Electrophysiological characteristics and catheter ablation in patients with paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation

Introduction: Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF.
Methods and Results: Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females; mean age 47 ± 18 years) with both PSVT and AF were divided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 ± 3 vs. 41 ± 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2.
Conclusion: The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome.     

射频消融治疗高龄老年人阵发性室上性心动过速14例

目的探讨射频消融（RFCA）治疗老年人室上性心动过速的有效性和安全性。方法采用常规方法射频消融治疗80岁以上阵发性室上性心动过速（PSVT）患者14例,其中慢径消融治疗房室结折返8例、旁路消融5例、线性消融房扑1例。结果80岁以上的高龄老年PSVT患者14（男11,女3）例,年龄8087（83.7±3.0）岁。主要并发症有高血压病、高脂血症、冠心病、慢性喘息型支气管炎、肺气肿、脑梗死、糖尿病、肥厚性心肌病和主动脉瓣狭窄等。先行冠状动脉造影术4例;髂动脉迂曲,选择对侧动脉或使用长血管鞘跨过迂曲部位消融成功3例;术中发生心衰1例,在导管操作及电生理检查中诱发房颤（AF）2例;主动脉瓣狭窄应用直接穿间隔法后消融1例;在放电时出现Ⅱ度房室传导阻滞1例,放电时出现Ⅰ度房室传导阻滞（PR间期大于0.24 s）2例。穿刺点出现血肿1例。14例患者均首次消融均成功,其中2例复发,再次消融成功。术后共随访624月,均未复发,也无传导阻滞等严重并发症发生。结论射频消融治疗高龄老年人室上性心动过速是有效、安全的。     

Combination therapy with aprindine and verapamil for paroxysmal supraventricular tachycardia as assessed by transesophageal atrial pacing

To assess the efficacy of combination therapy of aprindine (40 mg/day) and verapamil (160 mg/day), transesophageal programmed atrial stimulation was performed on 21 patients with paroxysmal supraventricular tachycardia (including 12 patients with atrioventricular nodal reentrant tachycardia and nine patients with atrioventricular reentrant tachycardia) under four conditions: a) control, b) aprindine alone, c) verapamil alone, and d) aprindine + verapamil. Results: a) Aprindine, verapamil, and aprindine + verapamil prevented paroxysmal supraventricular tachycardia induction in 2/21, 3/21, and 9/21 patients, respectively;b) aprindine + verapamil prolonged the cycle length of paroxysmal supraventricular tachycardia more than aprindine or verapamil alone; c) aprindine, verapamil, and aprindine + verapamil decreased the AV blocking rate by 15, 23, and 35 beats/min, respectively, in comparison with the control state; d) aprindine, verapamil, and aprindine + verapamil prolonged the effective refractory period of atrioventricular conduction system by 20, 34, and 76 msec, respectively, compared with the control state. In conclusion, aprindine + verapamil appear to be more effective than aprindine or verapamil alone in preventing paroxysmal supraventricular tachycardia with nodal reentry, but there was less benefit in those without nodal reentry (Wolff-Parkinson-White group).     

Comparative study of transesophageal atrial pacing and intracardiac electrophysiology in patients with supraventricular tachycardia

The diagnostic value of transesophageal atrial pacing in supraventricular tachycardia (SVT) has been discussed according to the comparison of the results of intracardiac and transesophageal electrophysiological study. Some quantitative criteria for the differential diagnosis of atrioventricular node reentrant tachycardia (RT-AVN) and atrioventricular reciprocating tachycardia (RT-AP) has been proposed. We found that RT-AVN and RT-AP could be separated by noninvasive transesophageal atrial pacing. We also suggested that induced SVT would be RT-AVN if (1) SR conductive curve was not continuous and SR jump greater than 70 ms, (2) AV interval less than 60 ms, and it would be RT-AP if (1) SR curve was continuous and there was no SR jump phenomenon, (2) VA interval greater than 100 ms. Thus, transesophageal atrial pacing was very helpful in distinguishing the mechanisms of SVT and could provide a simple clinical cardiac electrophysiological procedure in diagnosing SVTs.     

食管心房调搏诊断室上性心动过速的临床研究

为探讨食管心房调搏揭示室上性心动过速发生机制的价值和局限性,回顾性分析成功射频导管消融的１３８例隐匿性单房室旁道参与的顺向型房室折返性心动过速和１００例单一类型房室结折返性心动过速的食管心房调搏结果。结果显示：前１３８例中,３例前间隔旁道引起者食管心房调搏均诊断为房室结折返性心动过速余为左右侧其它部位的旁道,诊断正确。后１００例中,５例为慢－慢型,２例为快－慢型,食管心房调搏均诊断为房室折返性心动     

异丙肾上腺素在食道心房调搏术诱发阵发性室上性心动过速中的应用

目的:对比观察食道心房调搏术中基础刺激与基础刺激加异丙肾上腺素诱发室上性心动过速的诱发率。方法:302例临床拟诊阵发性室上性心动过速的患者被随机分成两组:基础刺激组(A组)151例,基础刺激加用异丙肾上腺素组(B组)151例,然后进行食道心房调搏检查。结果:B组的诱发成功率明显高于A组的(72.8%:41.1%,P0.01)。同时B组患者中,房室结双径路的诱发成功率明显大于房室旁道(76.8%:57.5%,P0.05)。结论:异丙肾上腺素能显著提高食道心房调搏术中阵发性室上性心动过速的诱发率,值得临床推广应用。